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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247209204
Report Date: 09/09/2024
Date Signed: 09/09/2024 12:59:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/15/2024 and conducted by Evaluator Brianna Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240415120719
FACILITY NAME:ANAYA ELDER CARE LLCFACILITY NUMBER:
247209204
ADMINISTRATOR:FERNANDEZ, DODERLEIN ANAYAFACILITY TYPE:
740
ADDRESS:2058 DANTE CTTELEPHONE:
(951) 772-9113
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:6CENSUS: 3DATE:
09/09/2024
UNANNOUNCEDTIME BEGAN:
10:54 AM
MET WITH:Administrator- Doderlein Anaya FernandezTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not ensure that resident's hygiene needs were met while in care.
INVESTIGATION FINDINGS:
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On 9/9/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to deliver the findings for the allegations listed above. LPA introduced herself and explained the reason for the visit. LPA met with Administrator (AD) Doderlein Anaya Fernandez.

1. The Department investigated the allegation: Staff did not ensure that resident's hygiene needs were met while in care. During the interviews LPA was informed and pictures were provided showing R1 to have bowel movement (BM) dried to the buttock area. Interviewees stated when they saw R1 they smelt of BM and urine.
Based on LPAs observations, interviews, which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter number 8, are being cited on the attached LIC 9099D.
Exit interview was conducted and a copy of this report LIC9099, LIC9099D, and appeal rights were provided to Administrator Doderlein Anaya Fernandez.
***Report Amended to add POC to LIC9099D***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20240415120719
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ANAYA ELDER CARE LLC
FACILITY NUMBER: 247209204
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2024
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities
(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:
(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
This requirement is not met as evidenced by:
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Administrator will conduct training and provide verification to LPA.
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Based on observation, interview, & record review the licensee did not comply with the regulation listed above which poses a potential health, safety, or personal rights risk to residents in care. LPA observed pictured which shows R1's hygiene needs were not being met. R1 was doubled briefed and soiled through their clothes.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2